Dimensions of cultural competence: Nurse-client perspectives.

다국어 초록 (Multilingual Abstract)

Cultural competence at the provider-client level has been suggested as a strategy to address health disparities. This study, using The Model of Culturally Congruent Care as a framework, examined cultural competence from the perspectives of nurses who provide care in the community and from the clients they serve. Seventy one nurses from home health, hospice and public health agencies completed The Cultural Competence Assessment which examined the nurses' cultural competence. The nurses also documented personal experiences providing culturally competent care. Sixty nine clients receiving care at public health agencies completed the Interpersonal Processes of Care - Short Form that examined the clients' perspectives of the nurses' communication, decision making and interpersonal style. Measures of central tendency were used to analyze findings from the Cultural Competence Assessment and the Interpersonal Processes of Care - Short Form. Multiple regression and one-way ANOVA were used to analyze additional findings from the Cultural Competence Assessment. Nurses reported moderately high levels of cultural awareness and sensitivity and moderate levels of culturally competent behaviors and overall cultural competence. Higher numbers of cultural diversity training experiences were found to predict higher performance of culturally competent behaviors and higher cultural competence. Public health nursing was found to predict lower performance of culturally competent behaviors and lower cultural competence than home health/hospice nursing. Public health nurses' scores on the Cultural Competence Assessment were significantly lower than home health/hospice nurses' scores. Content analysis of the nurses' documentation of personal experiences revealed requests for additional cultural competence training, the provision of culturally competent care that dealt with the language barrier and the lack of adequate numbers of appropriately trained interpreters. Clients rated the nurses' communication, decision making and interpersonal style as very high. Similarities were noted between the high frequency of specific nurse-reported culturally competent behaviors and client reported perceptions of the nurses' communication, decision making and interpersonal style indicating consistency between nurse and client responses. Implications for education of current and future health care providers, provision of adequate numbers of appropriately trained interpreters by health care systems and research into client outcomes resulting from culturally competent care are explored.